Provider Demographics
NPI:1992861272
Name:PERDUE, RHONDA S (PH D)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:S
Last Name:PERDUE
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 369
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-784-7767
Mailing Address - Fax:
Practice Address - Street 1:10111 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 369
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-784-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8783OtherGROUP NUMBER
FL59815YMedicare ID - Type Unspecified
FL59815Medicare UPIN